California State University, Chico
19-20
Authorization to Release Information - 3rd Party
Form must be submitted and/or completed in person
RETURN TO: Student Ser vices Ctr . 250
Financial Aid and Scholarship Office
Chico, CA 95929-0705
Phone: 530-898-6451 Fax: 530-898-6883
Email: finaid@csuchico.edu
Website: www.csuchico.edu/fa
Facebook: www.facebook.com/ChicoStateFASO
Student Last Name: Student First Name:
Chico State ID: Phone:
Email:
Address:
Street City State Zip
Types of Record(s) to be released:
Please be specific
Financial Aid Award Letter
Proof of Federal Work-Study
Other—specify:
___________
Name of Individual and Agency to Release Requested Information:
Name:
Agency:
Address:
Street
City Stat
e Zip
Please Check the Appropriate Box Identifying How You Wish To Have This Information Released:
Mail to Third Party
Mail to Student
Hold for Pick-Up
Fax ( )
If you are requesting release of paren
t(s) information given on the FAFSA or CADAA, your parent(s) must also sign this
release.
I hereby authorize Financial Aid information listed above to be released to the third party listed above.
Student Signature_______
________________________________________________________
____________Date____________
Parent #1 Signature (
Father/Mother/Stepparent) _________________________________
_______________ Date___________
Parent
#2 Signature (Father/Mother/Stepparent) _________________________________
_______________ Date
FOR OFFICE USE ONLY: Request completed: Date: ________________ Processor: ___________________________________
S-ver-AuthRelease3rdParty20
